CONTACTS 

SUBJECTS
2nd Opinion Verify Scope of Problem and Treatment Planning Tumor Boa
2nd Opinion Requested from UCSF, Stanford, UC Davis Cancer Centers

1204 -
1204 -    ..
1205 - Summary/Objective
1206 -
120601 - Follow up ref SDS 4 AW6M, ref SDS 1 AW6M.
120602 -
120603 - Assembled background.  Research on the Internet found three (3) cancer
120604 - centers in the area.  Sent the same letter to UCSF, and to Stanford,
120605 - becasue they have email addresses for referrals. ref SDS 0 K138  Will
120606 - call UC Davis on Monday, because they do not have an email address.
120607 -
120608 -
120609 -
120610 -
120612 -  ..
1207 -
1208 -
1209 - Background
1210 -
121001 - The record on 040517 lists relevant background.
121002 -
121003 -        Lump under left arm.................. 040517, ref SDS 2 OW3I
121004 -        IBC.................................. 040517, ref SDS 2 2F4G
121005 -        Tumor Board Report inadequate........ 040517, ref SDS 2 4R59
121006 -        Pending issues 2nd opinion........... 040614, ref SDS 3 RU5F
121008 -  ..
121009 - On 040909 Millie notified Kaiser to make a referral for a 2nd opinion
121010 - during a meeting with Doctor Johnson. ref SDS 4 AW6M
121012 -  ..
121013 - HMO patient rights to 2nd opinion paid for by insurance are reviewed
121014 - at...
121015 -
121016 -        http://www.kaiserpapers.org/secondop.html
121017 -
121018 -                        The Kaiser Papers
121019 -              How to get a Second Opinion Outside your HMO
121020 -
121021 - ...and citing the language in...
121023 -                          ..
121024 -                         HSC 1383.15
121025 -
121026 - ...which says in part...
121028 -         ..
121029 -    a)  When requested by an enrollee or participating health
121030 -        professional who is treating an enrollee, a health care service
121031 -        plan shall provide or authorize a second opinion by an
121032 -        appropriately qualified health care professional.
121034 -         ..
121035 -        Reasons for a second opinion to be provided or authorized shall
121036 -        include, but are not limited to, the following:
121038 -              ..
121039 -        (1)  If the enrollee questions the reasonableness or necessity
121040 -             of recommended surgical procedures.
121042 -              ..
121043 -        (2)  If the enrollee questions a diagnosis or plan of care for
121044 -             a condition that threatens loss of life, loss of limb,
121045 -             loss of bodily function, or substantial impairment,
121046 -             including, but not limited to, a serious chronic
121047 -             condition.
121049 -              ..
121050 -        (3)  If the clinical indications are not clear or are complex
121051 -             and confusing, a diagnosis is in doubt due to conflicting
121052 -             test results, or the treating health professional is
121053 -             unable to diagnose the condition, and the enrollee
121054 -             requests an additional diagnosis.
121056 -              ..
121057 -        (4)  If the treatment plan in progress is not improving the
121058 -             medical condition of the enrollee within an appropriate
121059 -             period of time given the diagnosis and plan of care, and
121060 -             the enrollee requests a second opinion regarding the
121061 -             diagnosis or continuance of the treatment.
121063 -              ..
121064 -        (5)  If the enrollee has attempted to follow the plan of care
121065 -             or consulted with the initial provider concerning serious
121066 -             concerns about the diagnosis or plan of care.
121068 -         ..
121069 -    b)  For purposes of this section, an appropriately qualified health
121070 -        care professional is a primary care physician or specialist who
121071 -        is acting within his or her scope of practice and who possesses
121072 -        a clinical background, including training and expertise,
121073 -        related to the particular illness, disease, condition or
121074 -        conditions associated with the request for a second opinion.
121075 -        For purposes of a specialized health care service plan, an
121076 -        appropriately qualified health care professional is a licensed
121077 -        health care provider who is acting within his or her scope of
121078 -        practice and who possesses a clinical background, including
121079 -        training and expertise, related to the particular illness,
121080 -        disease, condition or conditions associated with the request
121081 -        for a second opinion.
121083 -         ..
121084 -    c)  If an enrollee or participating health professional who is
121085 -        treating an enrollee requests a second opinion pursuant to this
121086 -        section, an authorization or denial shall be provided in an
121087 -        expeditious manner.  When the enrollee's condition is such that
121088 -        the enrollee faces an imminent and serious threat to his or her
121089 -        health, including, but not limited to, the potential loss of
121090 -        life, limb, or other major bodily function, or lack of
121091 -        timeliness that would be detrimental to the enrollee's ability
121092 -        to regain maximum function, the second opinion shall be
121093 -        authorized or denied in a timely fashion appropriate for the
121094 -        nature of the enrollee's condition, not to exceed 72 hours
121095 -        after the plan's receipt of the request, whenever possible.
121097 -         ..
121098 -        Each plan shall file with the Department of Managed Health Care
121099 -        timelines for responding to requests for second opinions for
121100 -        cases involving emergency needs, urgent care, and other
121101 -        requests by July 1, 2000, and within 30 days of any amendment
121102 -        to the timelines.  The timelines shall be made available to the
121103 -        public upon request.
121105 -         ..
121106 -    d)  If a health care service plan approves a request by an enrollee
121107 -        for a second opinion, the enrollee shall be responsible only
121108 -        for the costs of applicable copayments that the plan requires
121109 -        for similar referrals.
121111 -         ..
121112 -    e)  If the enrollee is requesting a second opinion about care from
121113 -        his or her primary care physician, the second opinion shall be
121114 -        provided by an appropriately qualified health care professional
121115 -        of the enrollee's choice within the same physician
121116 -        organization.
121118 -         ..
121119 -    f)  If the enrollee is requesting a second opinion about care from
121120 -        a specialist, the second opinion shall be provided by any
121121 -        provider of the enrollee's choice from any independent practice
121122 -        association or medical group within the network of the same or
121123 -        equivalent specialty.  If the specialist is not within the same
121124 -        physician organization, the plan shall incur the cost or
121125 -        negotiate the fee arrangements of that second opinion, beyond
121126 -        the applicable copayments which shall be paid by the enrollee.
121128 -         ..
121129 -        If not authorized by the plan, additional medical opinions not
121130 -        within the original physician organization shall be the
121131 -        responsibility of the enrollee.
121133 -         ..
121134 -    g)  If there is no participating plan provider within the network
121135 -        who meets the standard specified in subdivision (b), then the
121136 -        plan shall authorize a second opinion by an appropriately
121137 -        qualified health professional outside of the plan's provider
121138 -        network.  In approving a second opinion either inside or
121139 -        outside of the plan's provider network, the plan shall take
121140 -        into account the ability of the enrollee to travel to the
121141 -        provider.
121143 -         ..
121144 -    h)  The health care service plan shall require the second opinion
121145 -        health professional to provide the enrollee and the initial
121146 -        health professional with a consultation report, including any
121147 -        recommended procedures or tests that the second opinion health
121148 -        professional believes appropriate.  Nothing in this section
121149 -        shall be construed to prevent the plan from authorizing, based
121150 -        on its independent determination, additional medical opinions
121151 -        concerning the medical condition of an enrollee.
121153 -         ..
121154 -    i)  If the health care service plan denies a request by an enrollee
121155 -        for a second opinion, it shall notify the enrollee in writing
121156 -        of the reasons for the denial and shall inform the enrollee of
121157 -        the right to file a grievance with the plan.  The notice shall
121158 -        comply with subdivision (b) of Section 1368.02.
121160 -         ..
121161 -    j)  Unless authorized by the plan, in order for services to be
121162 -        covered the enrollee shall obtain services only from a provider
121163 -        who is participating in, or under contract with, the plan
121164 -        pursuant to the specific contract under which the enrollee is
121165 -        entitled to health care services.  The plan may limit referrals
121166 -        to its network of providers if there is a participating plan
121167 -        provider who meets the standard specified in subdivision (b).
121169 -         ..
121170 -    k)  This section shall not apply to health care service plan
121171 -        contracts that provide benefits to enrollees through preferred
121172 -        provider contracting arrangements if, subject to all other
121173 -        terms and conditions of the contract that apply generally to
121174 -        all other benefits, access to and coverage for second opinions
121175 -        are not limited.
121176 -
121177 -
121178 -
121179 -
121180 -
121181 -
121183 -  ..
121184 - Research today found...
121186 -     ..
121187 -    UCSF Medical Center
121188 -    UCSF Cancer Center
121189 -
121190 -
121191 -        Carol Franc Buck Breast Care Center
121192 -        1600 Divisadero, 2nd floor
121193 -        San Francisco, CA
121194 -
121195 -            http://cc.ucsf.edu/clinical/breast.html
121197 -         ..
121198 -        Appointments
121199 -        415/353-7070
121201 -         ..
121202 -        Offers...
121203 -
121204 -            Same-Day Assessment Program
121206 -             ..
121207 -            A specialized program to evaluate and diagnose abnormal
121208 -            mammograms and breast lumps the same day you are seen.  The
121209 -            one-day program includes consultation with surgeon,
121210 -            radiologist, and pathologist.
121212 -         ..
121213 -        Referral Numbers...
121214 -
121215 -
121216 -               http://cc.ucsf.edu/clinical/index.html
121217 -
121218 -            For Patients
121219 -            800.888.8664 (toll-free) or 415.885.7777
121220 -            email:  referral.center@ucsfmedicalcenter.org
121222 -             ..
121223 -            For Referring Physicians/Health Care Professionals
121224 -            800.444.2559 (toll-free) or 415.885.7777
121225 -            email: referral.center@ucsfmedicalcenter.org
121226 -
121228 -         ..
121229 -        UCSF Cancer Resource Center
121230 -
121231 -        Contact the CRC online, by phone or e-mail (415.885.3693,
121232 -        crc@ucsfmedctr.org), or in person at 1600 Divisadero Street,
121233 -        Room B101, San Francisco.
121234 -
121235 -           http://128.218.158.58/interact/crc/index.asp
121237 -         ..
121238 -        Provides Consultation Planning
121239 -
121241 -         ..
121242 -        Cancer Information Service
121243 -
121244 -        The NCI's Cancer Information Service offers free information
121245 -        and resources about cancer by calling 800.4.CANCER. On this
121246 -        site, CIS of California has provided answers to commonly asked
121247 -        questions
121248 -
121250 -         ..
121251 -        National Cancer Institute
121252 -
121253 -        The NCI is the most complete and authoritative source of
121254 -        cancer information, including advances in treatment,
121255 -        supportive care, screening, and prevention; comprehensive
121256 -        information on clinical trials; and directories of physicians
121257 -        and cancer organizations
121258 -
121259 -            http://cancernet.nci.nih.gov/
121260 -
121262 -     ..
121263 -    Stanford School of Medicine
121264 -    Department of Radiation Oncology
121265 -
121266 -
121267 -          http://www-radonc.stanford.edu/
121268 -
121269 -    Breast Cancer Treatment
121270 -
121271 -          http://cancer.stanfordhospital.com/cancerTypes/breast/surgery.html
121272 -
121274 -     ..
121275 -    Patient Care
121276 -
121277 -          http://radonc.stanford.edu/patient_care/
121279 -         ..
121280 -        Contact
121282 -         ..
121283 -        Jan Porter, L.C.S.W.
121284 -        Phone: 650-725-4765
121285 -        FAX: 650-725-8231
121286 -        E-mail: jporter@stanfordmed.org
121287 -
121289 -         ..
121290 -        Stanford Referral Center
121291 -
121292 -        You may contact us by phone at (800) 756-9000 or
121294 -         ..
121295 -        email:  referral@stanfordmed.org
121296 -
121297 -          http://www.stanfordhospital.com/forPatients/requestAppt/referralCenterConsumerSHCl
121298 -
121299 -
121301 -     ..
121302 -    UC Davis Cancer Center
121303 -
121304 -
121305 -           http://www.ucdmc.ucdavis.edu/cancer/
121307 -         ..
121308 -        Welcome to UC Davis Cancer Center. We are your NCI-designated
121309 -        cancer center - the only cancer center in our region to have
121310 -        achieved designation by the National Cancer Institute, the
121311 -        nation's top cancer organization
121313 -         ..
121314 -        Patient Referral Office
121315 -
121316 -           Call (916) 734-5900, toll-free (800) 362-5566, 8 a.m. to 5
121317 -           p.m., Monday through Friday or A faculty physician is always
121318 -           available to help speed the referral process.
121319 -
121321 -         ..
121322 -        Index of Resources at UC Davis Cancer Center...
121323 -
121324 -              http://www.ucdmc.ucdavis.edu/cancer/sitemap/index.html
121326 -         ..
121327 -        Breast Cancer
121328 -
121329 -              http://www.ucdmc.ucdavis.edu/cancer/about/program/breast_cancer_expertise.html
121331 -         ..
121332 -        A team of specialists at our breast evaluation clinic treats
121333 -        women with breast health concerns. We provide same-day
121334 -        diagnosis for breast lumps using fine needle aspiration biopsy.
121335 -        Lesions that cannot be felt are sampled with either fine needle
121336 -        or core needle using a computer-guided technique called
121337 -        stereotactic breast biopsy.
121339 -         ..
121340 -        Whenever possible, surgeons use breast-conserving treatments.
121341 -        This technique combines local removal of the tumor (lumpectomy)
121342 -        with radiation therapy. If a mastectomy is necessary, patients
121343 -        benefit from the latest techniques in breast reconstruction,
121344 -        which makes individualized reconstruction possible.
121345 -
121347 -  ..
121348 - Millie submitted ref DIT 1 0001 to UCSF and to Stanford...
121349 -
121350 -    1.  I need a 2nd opinion on my condition and treatment options.  I
121351 -        am currently being treated at Kaiser for breast cancer,
121352 -        originally diagnosed OA Feb 8, 2002.  In April of this year, I
121353 -        was diagnosed with IBC. ref DIT 1 0001
121354 -
121355 -            [On 041209 Stanford did not cite originating letter, and
121356 -            does not address any specific objective. ref SDS 10 LO5L
121358 -             ..
121359 -            [On 041209 Stanford addressed the 2nd opinion to Kaiser,
121360 -            rather than to the patient. ref SDS 10 LO5L
121362 -         ..
121363 -    2.  I have now completed 6 cycles on the Avastin protocol, and need
121364 -        to make a decision on whether to continue, stop and have a
121365 -        mastectomy, or simply to stop treatment altogether on the
121366 -        grounds that diagnostics using CT scans have not identified
121367 -        distant metastasis, and show that all tumors have been
121368 -        significantly reduced or been eliminated.  A complicating
121369 -        factor seems to be that if I opt for surgery, then I can no
121370 -        longer get treatment with Avastin, even if the evidence shows
121371 -        the treatment is effective.  So, there is a dilemma, and I need
121372 -        guidance on resolving it. ref DIT 1 P95M
121374 -         ..
121375 -    3.  CA 15-3 has declined from about 80 down to about 42, and lately
121376 -        went up slightly, then came down again, possibly indicating
121377 -        continuing cancer activity, or even failed treatment.  I am not
121378 -        sure from discussions with the attending physician what
121379 -        criteria establish success or failure of treatment. ref DIT 1
121380 -        J96M
121382 -         ..
121383 -    4.  Redness has largely, but not fully, been eliminated from the
121384 -        breast infected with IBC; I am not sure from discussions with
121385 -        the doctor about criteria for knowing when to decide about
121386 -        having surgery, which seems to be the standard treatment for
121387 -        IBC. ref DIT 1 U97J
121389 -         ..
121390 -    5.  I would like a physician to review the case history to see if
121391 -        anything has been overlooked that might indicate distant
121392 -        metastasis.  Kaiser had the case reviewed by a "Tumor Board" in
121393 -        April.  Their report did not seem comprehensive nor offer
121394 -        helpful guidance.  The Tumor Board made no finding on distant
121395 -        metastasis; the attending physician feels that lumps in the
121396 -        neck, which are symptoms of IBC, establish metastasis.  I want
121397 -        a 2nd opinion. ref DIT 1 E48F
121399 -         ..
121400 -    6.  If you need authorization to get the medical chart, please let
121401 -        me know. ref DIT 1 G48O
121403 -         ..
121404 -    7.  I would like to know if you can work through Kaiser for
121405 -        payment, or if you will be billing me directly, and in that
121406 -        case I need an estimate of the approximate cost for a 2nd
121407 -        opinion. ref DIT 1 P49H
121409 -         ..
121410 -    8.  Two case studies assembled following diagnosis of IBC in April,
121411 -        ref DIT 1 VX91, may facilitate your review...
121412 -
121413 -        (1)  Original diagnosis February 2002 lump under the arm,
121414 -             and in the breast. ref SDS 2 OW3I
121415 -
121416 -        (2)  IBC diagnosed in June 2004, symptoms appear to have begun
121417 -             in December 2002. ref SDS 2 2F4G
121430 -                  ..
121431 -                 [On 041012 Sheridan will notify the doctor to review
121432 -                 these case studies prior to meeting with Millie on
121433 -                 Monday, 041018. ref SDS 7 4Q8M
121435 -                  ..
121436 -                 [On 041018 Doctor Benz at UCSF reported he needed a
121437 -                 chronology of the case, but was unable to access the
121438 -                 record submitted today, ref SDS 9 EN5L, despite
121439 -                 coordination on 041012 where Sheridan notified the
121440 -                 doctor about the record by clicking a link,
121441 -                 ref SDS 7 664N, and despite coordinating with UCSF on
121442 -                 Friday 041015, ref SDS 8 GM7U, and despite planning to
121443 -                 meet with Sheridan prior to meeting with the doctor on
121444 -                 041018. ref SDS 9 LW5V
121445 -
121446 -
121447 -
121448 -
121449 -
121450 -
121451 -
121452 -
121453 -
1215 -